Clarksburg ERISA Disability Claim Denial

It can be devastating to learn that an insurance company has denied your disability claim. Being unable to work due puts a huge strain on your finances and can leave you filled with uncertainty about the future.

Fortunately, a denial does not have to be the last word. The federal law ERISA grants many Clarksburg workers the right to appeal their disability claim denials. These cases often require an in-depth legal and contractual analysis, however, so many people find it advantageous to work with an experienced ERISA attorney.

Reasons a Disability Claim May Be Denied

Insurance companies who pay disability benefits operate to make money. Therefore, they have a strong incentive to deny claims and may be looking for a reason to do so.

Some common reasons for an ERISA disability claim denial in Clarksburg include:

  • Filing after the deadline set forth in the policy
  • Failing to follow through with treatment recommended by the doctor
  • Lack of adequate documentation
  • Disagreement by the insurance company’s physician
  • Inaccurate or incomplete information on claim forms

In many cases, it is possible to remedy these problems during an appeal. Even if a claim is filed too late, the claimant may have a valid reason for the delay, which could provide grounds for reversing the denial. An attorney could help obtain and present information to provide sufficient documentation of the disability or to rebut the opinions of the insurance company’s doctor.

How to Appeal a Disability Claim Denial

The procedures for handling a denial will be determined by the terms of the insurance policy and whether that policy was provided through an employer. The federal Employee Retirement Income Security Act of 1974, most often referred to in Clarksburg by the acronym “ERISA,” governs policies provided by employers as a benefit to their employees.

ERISA allows an employee to file a claim in federal court to challenge disability claim denials. However, before filing a lawsuit, the disabled worker must first exhaust all administrative remedies. In effect, this means the insurance claimant must first appeal the denial using the insurance company’s internal procedures.

The policy or procedures established by the insurance company will dictate the steps in the internal appeals process. Some companies provide two stages of administrative appeal, while others have just one. An attorney could help an employee determine if they have exhausted applicable administrative appeals.

Filing an ERISA Disability Lawsuit

A disabled employee facing a denial or discontinuance of disability benefits may file a lawsuit in federal district court after exhausting internal remedies. It is important to ensure that the disability is well-documented at the earlier stages of the case, however, because the judge is not likely to review new evidence.

ERISA disability claim denials can be challenging to reverse in court unless the denial is found to be arbitrary and capricious. The best strategy is to ensure that a claimant’s eligibility for benefits is backed by the evidence presented to the insurance company.

Seek Help with a Clarksburg ERISA Disability Claim Denial

Many disability claimants wait until they are ready to file a lawsuit before consulting an ERISA lawyer. This can prove to be a mistake, however, because, by that point, they may have missed the best chance to present compelling evidence.

For this reason, it is wise to consult an experienced legal advocate as soon as possible after a Clarksburg ERISA disability claim denial. An attorney who understands the requirements of these claims could help a disabled worker fight for a positive resolution to their case.